Category Archives: self-harm and suicide

Self-harm accounts for over 24,000 hospital admissions every year¹ and it is estimated that 1 in 12 children self-harm². Rates in the UK are some of the highest in Europe³ but – because self-harm is, by its very nature, a private activity and is often kept secret and thus remains unreported – these statistics may be just the tip of the iceberg.

Self-harm is generally thought of to include violent acts to the self – specifically deliberately cutting, hitting, burning, injecting or imbibing potentially dangerous objects or substances, hair pulling, eating disorders etc. Smoking and drinking, over or under-exercising, engaging in risky sporting/driving/sexual behaviour, cosmetic surgery, tattooing and piercing may also be added to the list – although some may not consider many of behaviours in the second list to be harmful. Is eating a doughnut after a difficult meeting at work an act of self-harm or of self-care?

Self-harm is on the increase, and many wonder at the “contagious” aspect of the behavior – is it a way of crying out for help or attention; an act to externally express inner rage; a form of self-punishment; or just a way of “belonging” to a particular group?

Whilst working with a self-harming client can be very distressing, Lynn Martin references many examples of clients who, she feels, were kept alive by their self-harm(4). She refers to “anti-suicide” element of the behaviour, and explains that, for some, self-harm actually allows them to feel that they are in control of their lives. The endorphins, which are released into the blood stream after a puncture to the skin, can serve to somehow “re-boot” the depressed, withdrawn client who has lost touch with her world. Similarly, the pain of the wound can highlight that it hurts “here” rather than just “inside”.

As therapists, it is important that we do not allow any personal shock to spill out when working with a self-harming client. Showing concern for the wounds, and making sure that they are kept clean; ensuring, too, that the client is secure in the fact that you see them behind their pain; communicating that it is alright to talk about the self-harm; respecting the fact that the client is, more often than not, trying to survive and not to die; and reassuring the client that you will not try to steal from them their coping mechanism until they themselves feel safe enough to live without it – all these sort of responses are seen as being the most helpful to the truly distressed and pained client.

Whatever the reasons or the resolutions for the self-harming individual, as therapists we need to be aware of the width and prevalence of this behavior. We need, too, to look after ourselves whilst working with self-harming clients by exploring, in supervision, the myriad of reactions that this particularly violent representation of pain can produce in us.

Self-harming behaviours, such as cutting, scratching and hitting oneself, are often a physical way to deal with very painful psychological experiences and feelings of distress and isolation. Self harm can arise for all sorts of reasons such as grief, abuse, trauma, fear, loss and other feelings that are overwhelming. These may be from early childhood or in the present, or they may follow an incident that makes a person angry, frustrated or disappointed.

There is usually mounting tension followed by a compulsion or an impulsive need to self-harm. Some people dissociate (separate themselves so that they are not fully aware of their behaviour) from their mental and physical pain during the act of self-harm. Because others may see acts of self-harm as “deliberate”, unsympathetic responses can be a consequence. However, quite often a person is not very conscious of their reasons for self-harming and does not feel in control when they do it.

There are various forms of self harm, including cutting with a razor or knife, burning, hitting or banging your head, or over-dosing when it’s not life-threatening. It is often done in secret.

Self-harm has hidden short-term benefits for the person harming. These can include:

Release of emotions – getting them “out” can bring relief and decrease in tension

Making the mental pain feel real (akin to crying without tears, when the person can’t externalise their feelings)

Giving a distraction from, or a sense of pause, from the mental pain

Providing a way of telling others how bad you feel

Punishing the self for self-hatred and guilt

How does therapy help?

learning to manage feelings and difficulties in healthier ways, such as talking

exploring and understanding the circumstances in which the self-harm arises

understanding the unconscious conflicts and buried emotions underneath the acts of self harm

developing a capacity to contain, tolerate and think about distress

By: Wendy Bramham, July 2013

Remember:
Seek immediate help for any serious injury or overdose – with your GP, ambulance or A&E.

Thoughts from the front-line…

We asked a few teenagers to tell us in their own words how they would have liked their parents to support or help them. The purpose of this exercise was to inform and assist parents/guardians who may be unsure of how to help their child. Comments remain anonymous to protect identity.

Girls aged 14 and 15 told us:

“Further criticism is definitely something NOT to do, because most likely that is what caused the person to self-harm in the first place.”

“Parents shouldn’t pretend they understand, that is one of the most frustrating things for people in this situation. Perhaps saying they are trying to understand would be a better way.”

“Friends can play a large part in preventing further harm… I would get the parents to talk to their child’s friends to see if they have noticed anything.. make it subtle though!”

Girls aged 17 told us:

“For me, my parents couldn’t have really done anything to help me, my mum made me keep my door open at night and took away my razors, making me use hair removal cream instead. But that didn’t stop me and it wouldn’t stop anyone from doing it. There’s no way parents can stop it physically in all honesty. For me it was my own personal feelings of guilt and these weren’t gonna stop no matter how much my mum and dad tried to help. But the situation would’ve been a lot better if my mum had understood when I told her. She didn’t say anything and I feel like she didn’t understand why I did it. Maybe she thought it was some sort of cry for attention, but it wasn’t (I’d been hiding it for one and a half years). If she was more aware of the reasons why people do it, and maybe just gave me a hug, told me I would be okay, comforted me when I was upset about anything, then maybe it would have stopped me doing it sooner. But instead she never mentioned it to me, only tried to physically prevent me from doing it, not mentally”. FW

“What might have helped would be if I was not made to feel it was my fault or that I was a drama queen. Guilt is a key contributor to my issues and I was made to feel guilty for self-harming. I wanted my parents to understand that I wasn’t doing it because I hated them. I knew they would be heartbroken if I died, but when you’re mentally ‘effed up’ you don’t see it that way, and the selfishness that depression produces isn’t controllable. Self-harm isn’t always slitting your wrists. It can be pinching yourself under the table all lesson, or forcing your mind through horrible thoughts (emotional self-harm is a huge thing). Yes, we know we shouldn’t do it, we know it is bad for us, we know it’s selfish. Telling us this just makes us feel guilty, which makes us feel crapper which makes us more likely to lose control and do it again. When you get a cold or even cancer you don’t blame yourself or anyone else; you just look for a way to fix it. Sometimes we self-harm because it is the only way to feel alive. Yet, blaming the child for feeling so low is not healthy and will not make them forthcoming with reasons why.” MA

From the above stories, it is clear that it is helpful if parents/carers/relatives can try to understand the emotional distress underlying any self-harm behaviour in their child. It may be important for the parent to seek their own support, such as counselling, to cope better with this alarming situation. Wendy Bramham Therapy offers a range of therapists in Newbury & Marlborough who are qualified and experienced in helping with these issues, so please don’t hesitate to contact us.

Many of us were shocked and saddened by the news of Robin Williams’ suicide in August 2014. In 2013 as part of BBC Wiltshire’s series on mental health, Wendy Bramham spoke about this devastating issue. The following information offers a resource for people experiencing suicidal feelings; or for those bereaved by suicide; and for people who are attempting to help those affected by this issue.

What causes a person to feel suicidal?

Suicide may seem to be the only way to end severe mental pain; the only thing that’s left within the person’s control. It may also be a way to convey desperate feelings to others. Most people who feel suicidal are actually quite confused and conflicted about the desire for death. Most wish there was an alternative.

What causes it is usually a complex mix of factors that builds up into despair that becomes overwhelming. It may be caused by a sudden crisis, a major setback or loss, but more typically there is a slower build-up over time.

Many kinds of emotional pain can lead to thoughts of suicide. Each person responds and copes differently and uniquely to the myriad problems and crises we all encounter through life. Each person has their own psychological and social history and genetic make up, which means that what is bearable to one person can be unbearable to another, and vice versa.

Tragic Statistics

This devastating problem is much more common than many of us realise. Shockingly, in the UK suicide remains the most common form of death in men under the age of 35 (Mental Health Foundation and Department of Health). It is the second largest killer of people worldwide between the ages of 16-19. In the last 45 years suicide rates have increased by 60% worldwide (source: World Health Organisation).). It’s estimated that approximately 5% of people attempt suicide at least once in their life. Men are 3 to 4 times more likely to kill themselves than women. However, unsuccessful attempts are more common in women and young people. More people die by suicide each year than by murder and war combined.

Accusation of selfishness?

Some people accuse those who have committed suicide as selfish, and that they took the “easy way out”. This is extremely hurtful and shows a lack of understanding of mental illness and the suffering that some people try to endure. The following quote is taken from theguardian.com on 12 august by Dean Burnett who I think argues the point well:

“One of the main problems with mental illness is that it prevents you from thinking “normally” (although what that means is a discussion for another time). A depression sufferer is not thinking like a non-sufferer in the same way that someone who is drowning is not “breathing air” like a person on land is. (…..) The selfish accusation implies that there are other options that the sufferer has, but has chosen suicide or that it’s the easy way out. There are many ways to describe the sort of suffering that overrides a survival instinct that has evolved over millions of years, but ‘easy’ is not an obvious one to go for. Perhaps none of it makes sense from a logical perspective but insisting on logical thinking from someone in the grips of a mental illness is like insisting that someone with a broken leg walks normally. Logically you shouldn’t do that.”

Who is at risk?

Most important factors that put people at risk include mental disorders, such as depression, bipolar, schizophrenia, post-traumatic stress and obsessive-compulsive disorder (OCD). The second biggest influencing factor is substance abuse. Eg alcoholism is a factor in 15-60% of all suicides.

Having depression or bipolar increases the risk of suicide by 20%. Depression accounts for approximately 50% of suicides. Those suffering from severe depression and feelings of hopelessness, and who have little or no social support are probably the most at risk. Often people who are just recovering from depression are in fact more at risk of suicide, because it is then that they actually have the energy to carry out the act of suicide.

War veterans are a high risk category due to the mental trauma and physical ill-health from war. Genetics and social-economic factors play a part too, eg poverty, discrimination, financial worries, unemployment, bereavement, social isolation.

Some medical conditions can trigger suicidal feelings, such as traumatic head injuries. A diagnosis of cancer can double the risk of suicide. Such medical conditions can lead to depression and suicidal feelings, and carers should be aware of this.

Media and internet can cause a copycat syndrome of suicide whereby it is romanticised or glorified.

Warning signs

Suicidal feelings are more likely to build up when a person feels they can’t talk about their feelings. They may be experiencing or have experienced some of the following, which can also be signs and symptoms of depression:

withdrawal from friends, family and regular activities

isolation and hopelessness

sense of futility and meaningless

self-loathing (“everyone would be better off without me”)

loss of energy

major and sudden changes in personality or mood

big changes in sleeping and eating habits

difficulty in functioning, such as going to work, or cooking dinner

unusual neglect of personal appearance

feeling cut off from their body, feeling numb

impulsivity, lethargy or aggressiveness (especially in adolescents)

Obvious major warning signs include

talking about killing or harming oneself (it is a myth that people who talk about suicide don’t do it)

talking or writing a lot about death or dying

seeking out things that could be used in a suicide attempt, such as weapons and drugs.

The above signals are even more dangerous if the person has a mood disorder such as depression or bipolar disorder, suffers from alcohol dependence, has previously attempted suicide, or has a family history of suicide.

How to help someone who is suicidal

Talking about it can save a life. Try not to feel embarrassed or afraid. Talking about suicide won’t give the sufferer morbid thoughts – quite the opposite, it is the most helpful thing you can do.

However, it is not usually helpful to say things like “you should feel lucky because you’ve got a lovely house, job, family”, etc., or “that’s not enough of a reason to feel suicidal”. The best way to help is by offering an empathetic, listening ear. See notes below on “How to talk with someone about suicide”. Don’t take responsibility, however, for making the other person well. You can offer support, but you can’t get better for a suicidal person. He or she has to make a personal commitment to recovery. If you are helping a suicidal person, make sure you get support for yourself.

Practical steps:

Get professional help. Call a crisis line such as The Samaritans for advice and referrals. Encourage the person to see a counsellor, or take them to a doctor’s appointment.

Follow-up on treatment. If the doctor prescribes medication, encourage them to take it. Help to communicate about any side effects and be aware that it can be a trial and error process to find the right medication.

Be proactive. Don’t wait for the person to call you, or to return your calls. People who are severely depressed find it difficult to ask for help. Drop by, call again, invite the person out.

Encourage positive lifestyle changes, such as a healthy diet, plenty of sleep, and getting out in the sun or into nature for at least 30 minutes each day. Exercise is also extremely important as it releases endorphins, relieves stress, and promotes emotional well-being.

Make a safety plan, help the person develop a set of steps if they feel suicidal, such as who they will call. Include friends, family and crisis line numbers.

Remove potential means of suicide, such as pills, knives, razors, or firearms. If the person is likely to take an overdose, keep medications locked away or give out only as the person needs them.

Continue your support over the long haul. Even after the immediate suicidal crisis has passed, stay in touch with the person, periodically checking in or dropping by.

How to help yourself if you feel suicidal

Asking for help is not a sign of weakness but a sign of strength, wisdom and self-responsibility. If we try to do everything on our own we will become mentally, physically and emotionally exhausted.

However, if you have suicidal thoughts it can feel impossible to tell your family and friends how bad you feel. You may feel rage, fear, guilt and shame. If you have been hurt by someone, it is natural to feel anger, and sometimes suicide can seem a way to get back at that person. However, suicide is anger turned against ourselves.

The intense emotional pain that you’re experiencing right now can distort your thinking so it becomes harder to see possible solutions to problems, or to connect with those who can offer support.

It is important to work out with a professional counsellor why you feel the way you do. Give this process time and commitment even after you begin to feel better.

Coping strategies:

Promise not to do anything right now. Make a promise to yourself: “I will wait 24 hours and won’t do anything drastic during that time.” Or, wait a week. Wait and put some distance between your suicidal thoughts and suicidal action.

Avoid drugs and alcohol

Make your home safe.Remove things you could use to hurt yourself, such as pills, knives, razors, or firearms.

Take hope – people do get through this. Give yourself the time needed and don’t try to go it alone.

Speak to someone you trust,whether it be a friend, GP, clergyman, teacher, family member or therapist. Or call a helpline such as The Samaritans.

How to talk with someone who is (or might be) suicidal

·Recently, I have noticed some differences in you and wondered how you are doing.

·I wanted to check in with you because you haven’t seemed yourself lately.

Questions you can ask:

·When did you begin feeling like this?

·Did something happen that made you start feeling this way?

·How can I best support you right now?

·Have you thought about getting help?

What you can say that helps:

·You are not alone in this. I’m here for you.

·You may not believe it now, but the way you’re feeling will change.

·I may not be able to understand exactly how you feel, but I care about you and want to help.

·When you want to give up, tell yourself you will hold off for just one more day, hour, minute—whatever you can manage.

When talking to a suicidal person

Do:

·Be yourself. Let the person know you care, that he/she is not alone. The right words are often unimportant. If you are concerned, your voice and manner will show it.

·Listen. Let the suicidal person unload despair, ventilate anger. No matter how negative the conversation seems, the fact that it exists is a positive sign.

·Be sympathetic, non-judgmental, patient, calm, accepting. Your friend or family member is doing the right thing by talking about his/her feelings.

·Offer hope. Reassure the person that help is available and that the suicidal feelings are temporary. Let the person know that his or her life is important to you.

·If the person says things like, “I’m so depressed, I can’t go on,” ask the question: “Are you having thoughts of suicide?” You are not putting ideas in their head, you are showing that you are concerned, that you take them seriously, and that it’s OK for them to share their pain with you.

But don’t:

·Argue with the suicidal person. Avoid saying things like: “You have so much to live for,” “Your suicide will hurt your family,” or “Look on the bright side.”

·Act shocked, lecture on the value of life, or say that suicide is wrong.

·Promise confidentiality. Refuse to be sworn to secrecy. A life is at stake and you may need to speak to a mental health professional in order to keep the suicidal person safe. If you promise to keep your discussions secret, you may have to break your word.

·Offer ways to fix their problems, or give advice, or make them feel like they have to justify their suicidal feelings. It is not about how bad the problem is, but how badly it’s hurting your friend or loved one.

How to help someone who is bereaved by suicide

Bereavement by suicide can be more complicated because it is common for people to feel confused or guilty that they didn’t know the extent to which the person was suffering, and that they were not able to help. They may also feel angry and disappointed with the person who committed suicide. Because of stigma, they may feel they can’t talk about either the mental illness (if this was a factor) or suicide, adding to feelings of isolation. Bereavement by suicide often carries feelings of deep shame. Following information is taken from sane.org

Common responses:

I don’t know what to say.

·If not sure what to say, ask ‘ How are you feeling today? ‘

·Tell the person you’re not sure what to say. Being honest will help to build trust

I don’t want to make it worse for them. By allowing the person to express their grief you will be helping. Nothing you do can take away the sadness, but it is important to be there for them.

·Allow tears or accept no tears

·Understand that the way the person expresses grief may be different from the way you would express it

·Don’t take anger personally.

They have lots of family and friends around. They don’t need me. People with lots of friends and family still need support from others. It’s important to have grief acknowledged by friends and colleagues so the person doesn’t begin to feel isolated.

They need help from a professional. There is nothing I can do. While professional help can be very important, don’t underestimate the importance of friendship when someone is grieving. You can do things a professional person can’t such as going for walks, cooking a meal or being there in the evenings and on weekends, remembering the birthday and anniversaries of the person who died.

I’m not sure what to say about the mental illness. Ask the bereaved person how they feel about this and reassure them you are happy to talk about mental illness if they want. Seek out some information so you know something of what the person may have been experiencing. Be compassionate and understanding about difficulties it may have caused in their relationship, and encourage them to talk to a bereavement counsellor if they are not coping or do not feel they can talk to anyone else.

Useful Contact Numbers

Survivors of Bereavement by Suicide – 0844 561 6855

Samaritans – 08457 90 90 90

by: Wendy Bramham
Written as a resource for listeners of BBC Wiltshire mental health series, October 2013
Updated August 2014

Self-harming behaviours, such as cutting, scratching and hitting oneself, are often a physical way to deal with very painful psychological experiences and feelings of distress and isolation. Self harm can arise for all sorts of reasons such as grief, abuse, trauma, fear, loss and other feelings that are overwhelming. These may be from early childhood or in the present, or they may follow an incident that makes a person angry, frustrated or disappointed.

There is usually mounting tension followed by a compulsion or an impulsive need to self-harm. Some people dissociate (separate themselves so that they are not fully aware of their behaviour) from their mental and physical pain during the act of self-harm. Because others may see acts of self-harm as “deliberate”, unsympathetic responses can be a consequence. However, quite often a person is not very conscious of their reasons for self-harming and does not feel in control when they do it.

There are various forms of self harm, including cutting with a razor or knife, burning, hitting or banging your head, or over-dosing when it’s not life-threatening. It is often done in secret.

Self-harm has hidden short-term benefits for the person harming. These can include:

Release of emotions – getting them “out” can bring relief and decrease in tension

Making the mental pain feel real (akin to crying without tears, when the person can’t externalise their feelings)

Giving a distraction from, or a sense of pause, from the mental pain

Providing a way of telling others how bad you feel

Punishing the self for self-hatred and guilt

How does therapy help?

learning to manage feelings and difficulties in healthier ways, such as talking

exploring and understanding the circumstances in which the self-harm arises

understanding the unconscious conflicts and buried emotions underneath the acts of self harm

developing a capacity to contain, tolerate and think about distress

By: Wendy Bramham, July 2013
for BBC Radio Wiltshire

Remember:
Seek immediate help for any serious injury or overdose – with your GP, ambulance or A&E.